Advice needed for ARMY medical issue...

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Johnsson
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Advice needed for ARMY medical issue...

Post by Johnsson » Sat Feb 24, 2018 1:28 pm

I know we have both military and physicians here, so I'm hoping for some informed direction...

Keeping details to a minimum...

My child is in the US Army and has a function limiting orthopedic problem which needs surgery very soon. While this began overseas the concern is now here in the states. The problem is uncommon, so there are few experts in dealing with this problem.

As with any organization I'm sure there are fabulous surgeons along with some that are not so much, especially when dealing with an uncommon problem.

Is there any way, as a soldier in the Army, to ensure you have the best surgeon for the job? Or, possibly get a referral to a civilian surgeon?

My child will be pursuing this on their own and I want to provide whatever guidance I can to ensure a positive outcome.

Thank you!!

steadyhead66
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Re: Advice needed for ARMY medical issue...

Post by steadyhead66 » Sun Feb 25, 2018 2:11 pm

I would say, if it is an issue that the Army does not have the qualified Medical Personnel to treat, they will refer your child outside the military themselves.

Johnsson
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Re: Advice needed for ARMY medical issue...

Post by Johnsson » Sun Feb 25, 2018 4:03 pm

A better way of wording my concern would be...

I know a fair number of doctors (not in the Army) whose opinions of their own skills are far above reality. I'd like to avoid surgeons like this.

The Army is not known for providing their employees many choices. Maybe hospitals/physicians are different?

If the surgeon seems to be inadequate (by what is said or done by the surgeon, or by internet search of satisfaction with their work), is there any way to redirect to a surgeon that is more capable?

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Pajamas
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Re: Advice needed for ARMY medical issue...

Post by Pajamas » Sun Feb 25, 2018 4:11 pm

Wouldn't your son be the person best able to determine what his options actually are?

Unless it is an urgent situation, seems like it would be best to see where and to whom he is directed for treatment before deciding that another option would be better, anyway.

It is always okay to ask "Are there any other options?" at any point in treatment.

warner25
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Re: Advice needed for ARMY medical issue...

Post by warner25 » Sun Feb 25, 2018 4:39 pm

Many (most?) "Army" doctors/PAs/nurses/etc. are actually civilians who just happen to work on-post at the Army clinic or hospital, so the range of experience and expertise might be more broad than you think. And to be honest, orthopedic issues are probably bread-and-butter for Army medicine.

Your son has a primary care manager (PCM) who will refer him to a civilian office if there is no specialist on-post. If he has to travel far away, the Army will cover the expenses for his trip. Sending a Soldier across the country to Walter Reed to see a specialist is not uncommon in my experience.

If he feels that he's not getting what he needs from the specialist, he can go back to his PCM and ask for a new referral elsewhere (but there are no guarantees or entitlements, as far I as I know). He can also request a different PCM if one is available. The commander of his unit can also have some influence here on his behalf (commanders often talk to PCMs about the condition and treatment of their Soldiers through back channels).

The short answer is no, there isn't a way to ensure he gets "the best." But there are processes to ensure he gets reasonable care.

Johnsson
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Re: Advice needed for ARMY medical issue...

Post by Johnsson » Sun Feb 25, 2018 5:56 pm

warner25 wrote:
Sun Feb 25, 2018 4:39 pm
Many (most?) "Army" doctors/PAs/nurses/etc. are actually civilians who just happen to work on-post at the Army clinic or hospital, so the range of experience and expertise might be more broad than you think. And to be honest, orthopedic issues are probably bread-and-butter for Army medicine.

Your son has a primary care manager (PCM) who will refer him to a civilian office if there is no specialist on-post. If he has to travel far away, the Army will cover the expenses for his trip. Sending a Soldier across the country to Walter Reed to see a specialist is not uncommon in my experience.

If he feels that he's not getting what he needs from the specialist, he can go back to his PCM and ask for a new referral elsewhere (but there are no guarantees or entitlements, as far I as I know). He can also request a different PCM if one is available. The commander of his unit can also have some influence here on his behalf (commanders often talk to PCMs about the condition and treatment of their Soldiers through back channels).

The short answer is no, there isn't a way to ensure he gets "the best." But there are processes to ensure he gets reasonable care.
Thank you. There have been difficulties with the PCM in the past. It's helpful to know how the system is supposed to work and there should be options (in case options aren't freely offered).

brokendirtdart
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Re: Advice needed for ARMY medical issue...

Post by brokendirtdart » Sun Feb 25, 2018 5:59 pm

Johnsson wrote:
Sat Feb 24, 2018 1:28 pm


My child is in the US Army and has a function limiting orthopedic problem which needs surgery very soon.

<snip>

My child will be pursuing this on their own and I want to provide whatever guidance I can to ensure a positive outcome.
A concern from the outside looking in and from the organizational standpoint is the second statement here. Some of which may have been lost in translation from him to you. Based on the first statement, this is something which he is currently being treated for and has been determined to be a deployment limiting condition by his PCM or whomever he is seeing. Based on that, he likely has some options for further treatment in an attempt to bring him back to a deployable status and failing that, be eventually entered into the the process which decides his fitness for duty or future disability.

Then we have the second statement of him pursuing this on his own. Considering it is an organizational readiness issue, he really can't. While he will have plenty of options as warner25 detailed, he is going to have to do something to get fixed/other final outcome determined and his unit(commander) will have to be aware of his treatment. Note that some of that doesn't apply if he is in a reserve component.

totallystudly
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Re: Advice needed for ARMY medical issue...

Post by totallystudly » Mon Feb 26, 2018 12:55 am

Is there any way, as a soldier in the Army, to ensure you have the best surgeon for the job?

No. The most you can do is ask for a second opinion or seek to find out who at least a not terrible doctor/surgeon is for the issue. That is going to likely require a lot of research. You will typically be limited to whatever they have on post.

You can rock the boat a bit by going to IG or there was some hotline after the Walter Reed scandal that they setup for problem health care issues getting ignored. I've also found going to the post commanding general and requesting a sit down with a two star general does wonders for expediting a 6 month wait for a MRI till tomorrow.

Or, possibly get a referral to a civilian surgeon?

No. That isn't going to happen, unless there are zero doctors in the army that can fix the condition. Even then, it is often a Motrin 800 fix and they pass the buck on to the VA. Make sure your child details everything going on with them and works with a VSO to put in a disability claim

Totally incorrect on commanders talking via back channels. There are no back channels, and commanders up to the brigade level I had personal experience with lack the knowledge and don't really care beyond is person x deployable or not. They don't care about health care and aren't about to tell someone with a different COC and expertise how to do their jobs. I learned the hard way waiting for the system to work that it is my body and I have to take care of it.

brokendirtdart
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Re: Advice needed for ARMY medical issue...

Post by brokendirtdart » Mon Feb 26, 2018 6:49 am

totallystudly wrote:
Mon Feb 26, 2018 12:55 am

Totally incorrect on commanders talking via back channels.
I disagree with this point and have seen many conversations between PCM and commander regarding an individual's treatment.
totallystudly wrote:
Mon Feb 26, 2018 12:55 am
There are no back channels, and commanders up to the brigade level I had personal experience with lack the knowledge and don't really care beyond is person x deployable or not. They don't care about health care and aren't about to tell someone with a different COC and expertise how to do their jobs. I learned the hard way waiting for the system to work that it is my body and I have to take care of it.
This I agree with. While the commander may be discussing an individual's treatment with the PCM, his primary reason is to eventually turn that non deployable individual into a deployable individual or eventually see him move on to other things via the IDES process. Sometimes that is on the individual's behalf, but that isn't the primary reason for the unit getting involved. Unit readiness is a monthly reportable item, "readiness is the #1 priority", and now there are finally new DOD initiatives to further emphasize that.

totallystudly
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Re: Advice needed for ARMY medical issue...

Post by totallystudly » Mon Feb 26, 2018 7:14 am

I've never seen a commander or senior enlisted get involved in an individuals treatment, nor have I ever even heard of such a thing.

At most it is something like when I went to the commanding general and he essentially didn't want a pissed off officer in his office anymore ranting about why the general can't get this expletive Colonel to do his flipping job at the hospital or to just generally inquire what the treatment plan is or what stage of progress a person is in.

I think if you still are suggesting a Commander is going to intervene on behalf of a soldier to improve their care you are setting up unrealistic expectations. If the soldier has come condition x and isn't getting the right treatment or you think you need surgery, for example like when I had a grade 3 meniscus tear and they said to start with physical therapy, no Commander is going to call and persuade/order/cajole a doctor to do a surgery they don't want to do.

The operations commander isn't likely going to know the standard of care and the doctor may out rank the commander and is in a different chain of command even if they didn't.

bovineplane
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Re: Advice needed for ARMY medical issue...

Post by bovineplane » Mon Feb 26, 2018 7:34 am

AD PA. There is information missing here that a random internet forum could not possibly provide you good advice.

Below is just an example scenario and should in no way be construed as your son's situation.

If your son has a legitimate condition that needs specialty care he will be referred to the appropriate specialty. It is impossible to say if that will be a civilian or military as we do not have enough information. If the installation where he is assigned has the specialty or sub specialty then they get first right of refusal. This means when they receive the consult the one reviewing the consult can accept it in house or defer it to network. In either case he will get a first opinion. There are also access to care guidelines. I am not an expert but generally if the patient cannot be seen within 30 days they can push for network consult to meet access to care. Note I said seen and not treated. Two different things.

If he is not happy with the first opinion he has the right to ask for a second opinion, even in the military. Second opinions are handled in various ways from being handed to another provider in the same specialty in house to going to a network provider. This decision often falls back to the same provider reviewing the original consult.

As an example - if an ortho spine consult is placed. Patient has the visit with an ortho spine specialist. If the patient would like a second opinion he/she can ask for one. If there is a second ortho spine in house it could go to that provider although often some sub specialties there are only one. In this case it could go to an in house neuro surgeon if available. If neither is available then a network consult could be provided and generally is. If the condition is something more general, say internal medicine, often there is multiple providers who could provide a second opinion.

If sent to network then Tricare and the original specialty can determine if off-post treatments are provided or not. Some things Tricare will cover and some they wont. If the procedure is not covered by Tricare then generally it will not be approved although I have seen exceptions.
Like any insurance it gets complicated. As far as commanders getting involved in care as mentioned above, not likely. Imagine your boss going to your PCM or specialist and demanding care for you. Just doesn't make sense and most commanders understand that. I would also caution on seeking outside care. There are rules about seeking outside care not approved by his commander. Elective procedures (anything not life saving) require a memo to be approved. If a bad outcome were to occur through non-approved care he could be declared a non-line of duty injury and no coverage or disability provided.


Hopefully this helps as it is a very basic summary. If he has questions or concerns he can go visit a patient advocate at his assigned hospital. They all have them. He will just have to figure out where they are located. Often they can help clear things up like access to care, second opinions, etc.

brokendirtdart
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Re: Advice needed for ARMY medical issue...

Post by brokendirtdart » Mon Feb 26, 2018 8:35 am

totallystudly wrote:
Mon Feb 26, 2018 7:14 am


I think if you still are suggesting a Commander is going to intervene on behalf of a soldier to improve their care you are setting up unrealistic expectations.
Nobody is suggesting any such thing. The organization's primary concern is to turn a broken widget(OP's child) into a wholly functional and deployable widget. That occasionally requires the commander to speak with the PCM(if military) to find out the way ahead and length of time that widget will be broken so he can make a decision on readiness. This decision is a monthly requirement at company level and reportable monthly at battalion and higher level. Sometimes that is to the benefit of the widget, but that isn't the organization's primary concern.

Point being from the beginning is he is not pursuing this on his own as it is a readiness issue-read commander's concern and responsibilty. The docs in this thread have cleanly explained the options available to the OP's child as the individual receiving the care.

Furthermore, that communication is only available for the commander. The senior enlisted may be assisting in the administering of the organization's readiness, but only the commander has the requirement, responsibility, and legal ability to know the details.

warner25
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Re: Advice needed for ARMY medical issue...

Post by warner25 » Mon Feb 26, 2018 9:43 am

totallystudly wrote:
Mon Feb 26, 2018 12:55 am
Totally incorrect on commanders talking via back channels...
totallystudly wrote:
Mon Feb 26, 2018 7:14 am
I've never seen a commander or senior enlisted get involved in an individuals treatment, nor have I ever even heard of such a thing...
Notice I said that the commander can have some influence. Things will vary tremendously depending on circumstances. As a commander in a training unit, one of the priorities was to keep people moving along. This was big headache because, as you said, I'm not a doctor and the doctors didn't work for me, so it was frustrating to be put on the spot to answer what's wrong with my Soldier and what's being done about it. But we had a monthly meeting attended by all commanders up to the brigade level along with representatives from each care team at the clinic, plus physical therapy and behavioral health, to discuss issues by-name. Some providers definitely had an attitude of, "I don't answer to you." Other providers gave me their personal cell phone number and routinely sought my opinion as to the extent they should go to keep a Soldier on active duty vs. pursuing medical separation.

Providers have told me that they often need to discern whether a Soldier is really hurt or just trying to ride a profile, get out of a deployment, etc. Commanders can help there. Right or wrong, consciously or not, I think providers will handle the following patients differently: (a) a private in basic training, (b) a special forces NCO, (c) a battalion commander. Sometimes it helps if a commander speaks to someone on behalf of the private who might otherwise wait on the back-burner or be regarded with suspicion.

totallystudly
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Re: Advice needed for ARMY medical issue...

Post by totallystudly » Mon Feb 26, 2018 10:51 pm

Hopefully this helps as it is a very basic summary. If he has questions or concerns he can go visit a patient advocate at his assigned hospital.
If you want to waste a bunch of time and get nothing done, go talk to the patient advocate. If the people you are talking to don't have stars or eagles on their shoulders, you are wasting your time. A silver oakleaf *might* get things moving...maybe. If you want to move things along, I'd start with the post IG and finish at the commanding general's desk and if that doesn't solve it, write my congressman and start contacting news reporters.

If you are worried about health care and you aren't getting what you need for your own health, I take a pretty hostile, take no prisoners, do your job or I'm going to get you fired approach. That said, your child should do a large amount of research before so they have some idea of the issue and some idea of the solution they want. When I went in to the CG's office and said I have an issue that needs surgery, and I'm not waiting 6 months for an MRI and 6 months for physical therapy before they approve it, I want the MRI within a week and surgery within 30-60 days similarly scheduled, I got what I wanted...This was of course after getting the run around for 3 years.

Warner25, I agree that rank, position, and things do matter as far as your level of care/speed of care received. That said, I was a Captain and I was still getting the run around for years, so I had enough. I hope OP's child isn't an E-5 or below...

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